No clinically relevant difference between operative and non-operative treatment in tendon elongation measured with the Achilles tendon resting angle (ATRA) 1 year after acute Achilles tendon rupture

Background: Early functional mobilization (EFM) may improve patient outcome after Achilles tendon rupture (ATR). However, whether EFM affects patient outcome via changes in tendon elongation, thickening, or calf muscle atrophy is unknown. Purpose: To analyze differences in tendon and muscle morphology recovery over time between groups treated with EFM or standard treatment after ATR repair. Study Design: Cohort study; Level of evidence, 2. Methods: This prospective cohort study included 86 patients (20 women) with ATR repair who had a mean (SD) age of 39.3 (8.2) years and were part of a larger prospective randomized controlled trial. Patients were postoperatively randomized to immediate postoperative weightbearing and ankle motion (EFM group) or to immobilization in a below-knee plaster cast for 2 weeks (control group). Patient-reported and functional outcomes were assessed at 6 and 12 months with the Achilles Tendon Total Rupture Score and the heel-rise test for endurance. At 2 and 6 weeks and 6 and 12 months postoperatively, B-mode ultrasound imaging was performed to assess the length and cross-sectional area (CSA) of the Achilles tendon, the gastrocnemius CSA, as well as the thickness of soleus. Results: The Achilles Tendon Total Rupture Score for the EFM and control groups were 65.8 (18.7) and 56.8 (20.1; P = .045), respectively, at 6 months and 79.6 (15.8) and 78.9 (17.2; P = .87), respectively, at 12 months. At 2 weeks, tendon elongation was significantly more pronounced in the EFM group as compared with the control group (mean side-to-side difference, 1.88 cm vs 0.71 cm; P = .005). Subsequently, tendon elongation increased in the control group while it decreased in the EFM group so that at 6 and 12 months no significant differences between groups were found. Mean Achilles tendon elongation at 1 year was 1.73 (1.07) cm for the EFM group (n = 55) and 1.67 (0.92) cm for the control group (n = 27), with a mean difference of 0.06 cm (95% CI, 0.54 to –0.42; P = .80). Achilles tendon CSA and calf muscle atrophy displayed no significant differences between the groups; however, significant changes were demonstrated over time ( P ≤ .001) in both groups. Conclusion: EFM results in more Achilles tendon elongation at early healing, but this difference subsides over time. EFM does not seem to affect patient outcome via changes in tendon elongation, thickening, or calf muscle atrophy. Registration: NCT02318472 (ClinicalTrials.gov identifier).

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Commonly reported isokinetic parameters do not reveal long-term strength deficits of the Triceps surae complex following operative treatment of Achilles tendon rupture

Journal of Biomechanics ◽

10.1016/j.jbiomech.2020.109630 ◽

2020 ◽

Vol 101 ◽

pp. 109630 ◽

Cited By ~ 1

Author(s):

Josh Walker ◽

Gareth Nicholson ◽

Nils Jongerius ◽

Parag Parelkar ◽

Nick Harris ◽

...

Keyword(s):

Achilles Tendon ◽

Operative Treatment ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Triceps Surae ◽

Term Strength

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12 Efficacy of early controlled motion of the ankle in non-operative treatment of acute achilles tendon rupture. An assessor-blinded RCT

10.1136/bjsports-2019-scandinavianabs.12 ◽

2019 ◽

Cited By ~ 1

Author(s):

Kristoffer Weisskirchner Barfod ◽

Maria Swennergren Hansen ◽

Per Hölmich ◽

Morten Tange Kristensen ◽

Anders Troelsen

Keyword(s):

Achilles Tendon ◽

Operative Treatment ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Controlled Motion

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Tendon elongation and muscle function after repair of Achilles tendon rupture

Scandinavian Journal of Medicine and Science in Sports ◽

10.1111/j.1600-0838.1992.tb00334.x ◽

2007 ◽

Vol 2 (3) ◽

pp. 139-142 ◽

Cited By ~ 7

Author(s):

T. Wredmark ◽

C. A. Carlstedt

Keyword(s):

Achilles Tendon ◽

Muscle Function ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Tendon Elongation

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Operative Treatment of Acute Achilles Tendon Rupture: Open End-to-End-Reconstruction Versus Reconstruction with Mitek-Anchors

Acta Chirurgica Belgica ◽

10.1080/00015458.2008.11680210 ◽

2008 ◽

Vol 108 (2) ◽

pp. 236-239 ◽

Cited By ~ 1

Author(s):

T.J.A. Schönberger ◽

H.M.J. Janzing ◽

J.W. Morrenhof ◽

A.C. de Visser ◽

P. Muitjens

Keyword(s):

Achilles Tendon ◽

Operative Treatment ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

End To End

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Use of ankle resting angle as a surrogate for tendon elongation in individuals following Achilles tendon rupture

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000182 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0001

Author(s):

Heather Gotha ◽

Jennifer Zellers ◽

Karin Silbernagel

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Cost Effective ◽

Cross Sectional Study ◽

Plantar Flexors ◽

Cross Sectional ◽

Tendon Length ◽

Tendon Elongation ◽

The Relationship

Category: Ankle, Sports Introduction/Purpose: Tendon elongation is associated with poor functional outcome in individuals after Achilles tendon rupture. While imaging modalities are reliable to measure Achilles tendon length, alternative time- and cost-effective measures are of interest. The resting angle of the ankle in prone both with knee extended1 and knee flexed2 have been used in the literature as surrogates for measuring Achilles elongation, however, their relationship to tendon length is not well-established. The purpose of this study is to validate the ankle resting angle as a measure of tendon elongation and examine the relationship of ankle resting angle to tendon elongation and calf strength. Methods: Individuals following unilateral Achilles tendon rupture, treated surgically, were included in this cross-sectional study. Individuals were excluded if they had deep wound infection or lumbar radiculopathy affecting the ankle plantar flexors. Ankle resting angle with knee extended and knee flexed to 90 degrees was measured using a digital inclinometer positioned on the lateral, plantar surface of the foot. Relative resting angle was calculated by subtracting the uninjured from the injured side. Tendon length to gastrocnemius was measured using B mode, extended field of view ultrasound imaging3 (tendon elongation = ruptured- uninjured). Calf strength was measured using the heel-rise test4. Limb symmetry indexes (LSI) were calculated (ruptured/uninjured sidex100) for total work performed on the heel-rise test. Results: Twenty-five individuals, a mean(SD) age of 44.2(13.6) years and mean(SD) of 22.5(39.1) months post-rupture, were included in this study. Mean(SD) relative resting angle with knee flexed was -5.4(6.4)° and mean (SD) relative resting angle with knee extended was -6.7(8.8)°. Mean(SD) tendon elongation was 1.56(1.20)cm. Mean(SD) heel-rise test work LSI was 45.8(23.8)%. Ankle resting angle with knee flexed related to elongation (r = -0.452, p = 0.027) and heel-rise test work LSI (r = 0.591, p=0.006). Ankle resting angle with knee extended related to elongation (r=-0.528, p=0.008) (Figure 1) but not heel-rise test work LSI. Conclusion: The results of this study suggest that ankle resting angle with knee extended and flexed are related to tendon elongation, however, calf strength also has a relationship to resting angle with knee flexed. This suggests that the ability of the calf to put passive tension on the foot is also a component of resting angle. The relationship between tendon elongation and resting angle with knee flexed may have been limited by methodological concerns, as tendon length was measured with the participant positioned with knees extended.

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Outcome after operative treatment for chronic versus acute Achilles tendon rupture — A comparative analysis

Foot and Ankle Surgery ◽

10.1016/j.fas.2016.12.003 ◽

2018 ◽

Vol 24 (2) ◽

pp. 110-114 ◽

Cited By ~ 7

Author(s):

C. Becher ◽

S. Donner ◽

J. Brucker ◽

K. Daniilidis ◽

H. Thermann

Keyword(s):

Comparative Analysis ◽

Achilles Tendon ◽

Operative Treatment ◽

Tendon Rupture ◽

Achilles Tendon Rupture

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Operative versus Nonoperative Management of Acute Achilles Tendon Rupture

The American Journal of Sports Medicine ◽

10.1177/03635465020300060501 ◽

2002 ◽

Vol 30 (6) ◽

pp. 783-790 ◽

Cited By ~ 83

Author(s):

Mininder S. Kocher ◽

Julius Bishop ◽

Ryan Marshall ◽

Karen K. Briggs ◽

Richard J. Hawkins

Keyword(s):

Decision Making ◽

Achilles Tendon ◽

Operative Treatment ◽

Management Strategy ◽

Tendon Rupture ◽

Nonoperative Management ◽

Achilles Tendon Rupture ◽

Back Analysis ◽

Major Complication ◽

Optimal Management

Background The optimal management strategy for acute Achilles tendon rupture is controversial. Purpose To determine the optimal management by using expected-value decision analysis. Study Design Cross-sectional study. Methods Outcome probabilities were determined from a systematic literature review, and patient-derived utility values were obtained from a visual analog scale questionnaire. A decision tree was constructed, and fold-back analysis was used to determine optimal treatment. Sensitivity analyses were used to determine the effect of varying outcome probabilities and utilities on decision-making. Results Outcome probabilities (expressed as operative; nonoperative) were as follows: well (0.762; 0.846), rerupture (0.022; 0.121), major complication (0.030; 0.025), moderate complication (0.075; 0.003), and mild complication (0.111; 0.005). Outcome utility values were well operative (7.9), well nonoperative (7.0), rerupture (2.6), major complication (1.0), moderate complication (3.5), and mild complication (4.7). Fold-back analysis revealed operative treatment as the optimal management strategy (6.89 versus 6.30). Threshold values were determined for the probability of a moderate complication from operative treatment (0.21) and the utility of rerupture (6.8). Conclusions Operative management was the optimal strategy, given the outcome probabilities and patient utilities we studied. Nonoperative management was favored by increasing rates of operative complications; operative, by decreasing utility of rerupture. We advocate a model of doctor-patient shared decision-making in which both outcome probabilities and patient preferences are considered.

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